Attack, flare-up, or exacerbation? The terminology preferences of patients with severe asthma

Kimberley A Jones; Peter G Gibson; Janelle Yorke; Robert Niven; Amber Smith; Vanessa M McDonald

doi:10.1080/02770903.2019.1665064

Attack, flare-up, or exacerbation? The terminology preferences of patients with severe asthma

J Asthma. 2021 Feb;58(2):141-150. doi: 10.1080/02770903.2019.1665064. Epub 2019 Sep 16.

Authors

Kimberley A Jones^{1

2

3

4}, Peter G Gibson^{1

2

4

5}, Janelle Yorke^{3

6

7}, Robert Niven⁸, Amber Smith^{2

3}, Vanessa M McDonald^{1

2

3

4

5

6}

Affiliations

¹ National Health and Medical Research Council Centre of Excellence in Severe Asthma, Newcastle, Australia.
² Priority Research Centre for Healthy Lungs, The University of Newcastle, New Lambton, Australia.
³ School of Nursing and Midwifery, The University of Newcastle, Callaghan, Australia.
⁴ Hunter Medical Research Institute, New Lambton, Australia.
⁵ Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia.
⁶ Division of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK.
⁷ Christie NHS Foundation Trust, Manchester, UK.
⁸ Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.

PMID: 31490698
DOI: 10.1080/02770903.2019.1665064

Abstract

Background: People with severe asthma experience frequent life-threatening acute asthma events. A Lancet commission recently highlighted that terms "exacerbations" and "flare-ups" are seen to trivialize these episodes and recommended use of the term "attacks." Clinicians however, preferentially use the term "exacerbation" and some guidelines recommend the use of "exacerbation" with patients.Objective: This descriptive qualitative study aimed to understand the patient's experience and perspectives of these events and language used to describe them.Methods: Semi-structured one-on-one interviews were conducted in Australia and the UK in 18 people with severe asthma and 10 with mild-moderate asthma regarding their usage and preferences for such terminologies. Additionally, nine people with severe asthma participated in two focus groups in which use of preferred terminology was explored.Results: Mean age of participants was 57 ± 14.03 yr and 65% were female. A total 67 quotes were recorded in which 16 participants with severe asthma spontaneously used either the term "attack," "flare-up" and/or "exacerbation." Of these quotes, all 16 participants used "attack," one used all three terms and two used both "exacerbation" and "attack." The term "attack" was used to describe frightening events having major impacts on participant's lives, whereas "exacerbation" and "flare-up" were used to refer to both severe and mild, transient asthma-related events.Conclusion: Usage of the term "attack" was preferred by patients with severe asthma. Adoption of this language may assist in patient-clinician communication and disease management and outcomes. Wider stakeholder engagement is needed to confirm this suggestion. AbbreviationsFEV₁forced expiratory volume in 1 secondATSAmerican Thoracic SocietyERSEuropean Respiratory SocietyACQAsthma Control QuestionnaireICSinhaled corticosteroidsOCSoral corticosteroidsBTSBritish Thoracic SocietySIGNScottish Intercollegiate Guidelines NetworkWAPwritten action plan.

Keywords: Asthma; asthma attack; disease management; exacerbation; flare-up; patient-clinician communication; terminology.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Asthma / drug therapy
Asthma / physiopathology*
Asthma / psychology*
Australia
Disease Progression
Female
Humans
Interviews as Topic
Male
Middle Aged
Patient Acuity*
Qualitative Research
Respiratory Function Tests
Terminology as Topic*